Lecture 10: Obesity Flashcards
How long should a mother exclusively breastfeed?
AAP recommendation
First six months
What are the benefits of BFeeding?
- Protective effect against most illnesses
- Reduce risk of SIDS
- Reduce risk of obesity
- BFeeding mothers have reduced risk of postpartum hemorrhage
What are the disadvantages of BFeeding?
- Tired
- Mother is on special meds
- Baby needs special diet
- Cannot Bfeed if alcoholic or on drugs
- Need to supplement Vit D still
When do you feed a baby?
When its hungry
How do you know a baby is hungry?
- Licking lips
- Sticking tongue out
- Rooting
- Hand to mouth
- Opening mouth
- Fussy
- Sucking on everything (altho sucking can also be for comfort)
Hunger cues
Crying is a LATE sign of hunger
How often does a newborn eat on average?
Every 2-3 hours
For BFeeding
How do newborn feeding amts increase?
- First days of life: 0.5 oz/feed
- 1-2 weeks: 1-2 oz/feed
- 2 weeks: 2-3 oz/feed
- 2 Months: 2-4 oz/feed (feeding slows Q3-4h)
- 4 months: 4-6 oz/feed
- 6 months: 6-8 oz/feed (feeding slows Q4-5h)
Formula-wise: 1oz per month until they get to 7-8 oz/feed.
What kind of baby is most likely to overfeed?
Bottle fed
How do you know a baby is getting enough to eat?
- Beginning days: 2-3 WET diapers daily.
- By 1 week: 5-6 WET diapers daily.
How much Vit D does a baby need?
400 IU QD until they drink 1 qt of whole milk
Milk would not start until 1 year at minimum.
What kind of babies need Vit D supplementation?
Any baby being BFeed or not drinking at least 32oz of formula
What is the recommended iron supplementation for a newborn baby being BFed?
1mg/kg/d of liquid iron until 6 months
They usually start eating food with iron by 6mo.
What is the recommended iron supplementation for a newborn baby being Formula-Fed?
Just use iron-fortified formula for the first year
How does a baby’s wt change in the first 2 weeks of life?
DROPS by 7%
How much wt do we expect a baby to gain daily?
15g
100-120 kcal/kg/d needed for this.
When do you first recheck a newborn’s wt?
3-5 days after its born.
You would expect a small DROP in wt.
How does formula affect future obesity?
High risk for obesity in childhood.
What are the biggest benefits of formula?
- Catering to special needs (MPA, galacto, etc)
- No other supplementation is generally required.
When can you start single grain rice cereal at the earliest?
4 months via a spoon BID
When can you start meats in children?
9 months of age
What 4 things signal a child is ready for complementary feeding?
- Can hold head up unassisted
- Can sit unassisted
- Bring objects to mouth (interest)
- Ability to track spoon and open mouth
What is the danger of introducing peanut foods in the first year to an infant?
It is preferred that you DO introduce them to it to reduce their risk of developing an allergy to it.
Unless you have anaphylaxis to it i guess
When is juice recommended to children?
NEVER
Diabetes!!
How do milk recommendations change for a baby?
- 16 oz of Whole milk starting at age 1.
- Switch to skim/2% at age 2.
How many meals/snacks should a 2 year old eat daily?
- 3 healthy meals
- 2 snacks
When does a baby start getting picky?
Around age 1
When should you start flintstone vitamins for a kid?
18mo, start with 1/2
What is the suggested macronutrient breakdown for a baby?
- 55-60% carbs
- < 30% fats
- 10% Protein?
When are chunks of food a choking hazard for kids?
Under 4
What is the approximate ratio of calories to height for a kid?
40 cal/inch
32 inches = 1300 cal
What did the Bogalusa study reveal about childhood obesity and adult obesity?
Obesity at 2-5 years old = 90% chance of obesity as an adult
What is the risk for a child to become obese if 1 parent is? Both parents?
- 1 parent: 3x risk
- Both parents: 15x risk
What are the not so obvious RFs for obesity?
- Later bedtime
- Ghrelin/leptin hormone dysfunction
- Diabetic mothers
Which hormone, as it rises, makes us LESS hungry?
Leptin
Which hormone, as it rises, makes us MORE HUNGRY?
Ghrelin
Ghrelin Gets Hungry
How does wt gain affect leptin?
- More fat = more leptin
- More leptin = body starts getting resistant to it
- Your brain thinks you’re hungry
What medications are associated with obesity?
- Glucocorticoids
- Megace (appetite stimulant)
- Sulfonylureas (Glipizide, glyburide)
- TCAs
- MAOIs
- OCPs
- Insulin (excess)
- TZDs
- Risperidone
- Clozapine
What hormones among these are increased in obesity?
- Leptin
- Estrogens
- Cortisol
- GH
- Insulin
- Testosterone (male/female)
- Leptin = INCREASED
- Estrogens = INCREASED
- Cortisol = INCREASED
- GH = DECREASED
- Insulin = resistance
- Testosterone = DECREASED in men, increased in women
At what BMI percentile are you considered overweight as a child?
85th or higher
What two abdominal organs are we concerned most about in our ROS for an obese child?
- Gallbladder
- Fatty Liver
What disease should we question in the ROS for an obese child?
Diabetes!!!!
polyuria, polydipsia, GU itches, blurry vision
What is the ideal approach when discussing weight?
- Use nicer terms like excess weight or elevated BMI
- Show them a growth chart
- Emphasize that lowering BMI even a little lowers CV risk!
What is the general AAP recommendation regarding cholesterol screening in children?
ALL children 9-11 should get screened.
When is it indicated to screen a child earlier than 10y for cholesterol?
- Parents/GP had ACS/CVA prior to 55 in men, 65 in women.
- Parents/GP have total cholesterol > 240
- Child has heart dz, DM, HTN, smoking, obese, or unknown.
What does 5 2 1 0 mean?
- 5 fruits/veggies a day
- 2 hours of screen time max
- 1 hour of play daily
- 0 sugar-sweetened drinks
What is the recommendation regarding diet drinks?
NO DIET DRINKS!
Makes you wanna snack even more
Recommendation regarding low-fat diets in children?
NO! You want to just aim for healthier fats, not less.
Unsaturated fats are your friends: MUFAs and PUFAs
What are the 4 golden rules of eating?
- Divide responsibilities
- Eat when you’re hungry, stop when you’re full
- Do not force your child to clean the plate!!!
- Eat together
What does lack of sleep do to your hormones?
- Increased ghrelin
- Decreased leptin
- Increased evening cortisol => insulin resistance
Sleep is #1
What is the #1 cause for bullying at school?
Obesity
What is the FDA approved tx for obesity?
Technically not for children
Qsymia (topiramate/phentermine combo)
Generally, what are the minimum requirements for a bariatric sx?
- Older than 15
- BMI >= 40 or beyond 100% of IBW
Safest/reversible bariatric procedure?
Laparoscopic Adjustable Gastric Banding (LAGB)
What is the guideline regarding Vit D levels of around 20-29?
Normal > 30
- D3 OTC 1000U daily
- Q3mo checks
What is the guideline regarding Vit D levels of < 20?
Normal > 30
- D2 (Rx) 50,000U/week
- Q3mo
What underlying female condition may lead to obesity?
PCOS
What genetic male condition may lead to obesity?
Klinefelter
Low T, and often are obese when adolescents.
Metabolic syndrome criteria in children
- Waist circumference >= 90th percentile
- HTN >= 90th percentile
- Hypertriglyceridemia >= 110
- Impaired glucose/FBG >= 110
- Low HDL <= 40
Waist & HTN >= 90, HTG & FBG >= 110, HCL <= 40
What is the MC syndrome form of obesity?
Prader Willi Syndrome
Where is the Prader Willi Syndrome abnormality?
Chromosome 15q
Loss of paternally expressed genes
How does Prader Willi Syndrome present?
- Short w/ GH deficiency
- Hyperphagia w/ obesity
- Resistant to diet and exercise
Why is dieting and exercise hard in Prader Willi Syndrome?
- Hypotonia
- Hyperphagia drive is insatiable :(
- They have low metabolism due to their hormonal imbalances
They wanna eat no matter what :(
What are the major criteria for PWS? (7)
1 pt ea
- Hypotonia
- Feeding issues
- Excessive Wt gain
- Hypogonadism
- Facial anomalies
- Developmental delay
- Hyperphagia
Although I think hyperphagia and obesity are part of the same criteria… There’s only 6 major criteria on google
Overall, how do we approach monitoring pediatric obesity?
- Q1-3 mo
- If no change in 3-6 mo, call wt loss and dietician
